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NPI Code Detail

MEDICARE: RULON MARK HINCKLEY PHD, LMFT

MEDICARE: RULON MARK HINCKLEY PHD, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1168163501UT

General Provider Information

NPI Number : 1679638191
Entity Type Code : Individual
Provider Name (Legal Business Name) : RULON MARK HINCKLEY PHD, LMFT
Provider Business Mailing Address
First Line : 11175 S REDWOOD RD
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-8208
Country : US
Telephone Number : 801-484-9911
Fax Number : 801-302-7954
Provider Business Practice Location Address
First Line : 11175 S REDWOOD RD
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-8208
Country : US
Telephone Number : 801-484-9911
Fax Number : 801-302-7954
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2006
Last Update Date : 07/08/2007

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